Efficacy of Partial Nephrectomy in the Management of Unpredicted pT3a Renal Cell Carcinoma

Purpose: To compare the oncological outcomes between patients with pathologic T3a (pT3a) renal cell carcinoma (RCC) who underwent partial nephrectomy (PN) and radical nephrectomy (RN).Materials and Methods: We retrospectively reviewed 149 patients with pT3a N0 M0 RCC who underwent PN and RN between 2001 and 2012. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method and prognostic factors were identified using Cox proportional hazard regression models.Results: A total of 41 recurrences (27.5%) and 24 cancer related death (16.1%) were observed during a median follow-up of 136 months (interquartile range, 77–163 months). We observed no significant differences in the RFS and CSS between the PN and RN (RFS: 85.4±64.0 months vs. 75.9±52.8 months, p=0.061; CSS: 153.2±52.5 months vs. 124.9±59.8 months, p=0.292). The surgical method did not affect the tumor recurrence and patients’ survival. On multivariable Cox regression analysis, only tumor size remained associated with worse RFS (hazard ratio [HR], 1.237; 95% confidence interval [CI], 1.132–1.350; p<0.001) and CSS (HR, 1.156; 95% CI, 1.027–1.302; p=0.017).Conclusions: Due to the large tumor size, there may be hesitation in performing PN concerning pT3a in postoperative biopsy. Our study findings suggest that since tumor size is the only prognostic factor, PN can be performed in pT3a as long as there is no thrombus in the renal vein.